Vagus nerve neuritis. Pathologies of the vagus nerve: symptoms, diagnosis, treatment methods. Vagus nerve tone - symptoms

It happens that a person adheres to principles healthy image life and proper nutrition, does not abuse alcohol or smoke, even plays sports, but suddenly his health begins to deteriorate: severe headache, attacks of suffocation, interruptions in heart function, pain in the epigastrium. Often the cause of these ailments is diseases of the vagus nerve. Where is vagus nerve, what is it, how does it function and affect our well-being?

Functions of the vagus nerve

There are twelve pairs of nerves that originate from the base of the skull. One of the most important among them is the X pair. IN medical literature this formation is called “vagus” - wandering or wandering. The name is due to the fact that this nerve trunk is long and has many branches.

The vagus nerve is the largest nerve human body, it originates at the base of the skull, passes the neck, then the chest, descending to the peritoneum.

There are 3 nuclei of the vagus nerve:

• motor- transmits nerve signals from the brain to muscle fibers larynx, pharynx and soft palate;
• sensitive- it carries impulses to the brain from the external ear canal, organs respiratory systems s, esophagus, stomach and myocardium;
• secretory- through it the influence of the vagus nerve on the heart, the lumen of the bronchi is expressed, blood vessels and intestinal motility.

Thus, the branches of the vagus nerve connect the brain and most vital important organs. This is due to the wide range of functions performed by this nerve formation.

Processes controlled by the vagus nerve:

• activity of the cardiovascular and respiratory systems, stomach and pancreas;
• speech;
• swallowing, gag and cough reflexes.

The vagus nerve reduces the heart rate and, as a result, blood pressure, expands the lumen of the bronchi, increases the amount of secretions produced by the stomach and pancreas, helps the body cope with stress, is integral part solar plexus. The vagus nerve function is activated at night.

Causes of lesions

The nervous system is extremely vulnerable, and the vagus nerve is no exception. The main reasons for its damage may be:

• diabetes mellitus- provokes inflammatory lesions of blood vessels due to higher level blood glucose;
• chronic pathologies - often the consequences of HIV or Parkinson's disease, since these diseases negatively affect nerve fibers;
• injuries and surgical interventions as a result of which the nerve was damaged or pinched;
• tumors and hematomas putting pressure on the nerve;
• alcoholism - it leads to damage to the structure of nerve fibers (alcoholic neuropathy);
• severe infections;
• poisoning with toxic substances that have the ability to damage nerve structures;
• stressful situations.

Symptoms

Damage to the vagus nerve has very diverse manifestations, which depend on the mechanism of development of the pathology.

Inflammation of the vagus nerve (neuralgia)

Symptoms:

• voice disturbances, up to significant changes and difficulties in pronunciation;
• disturbance of the act of swallowing with the subsequent development of pathological gag reflexes (unreasonable), followed by a feeling of lack of air;
• dizziness.

Irritation of the vagus nerve (neurasthenia)

Symptoms:

• sudden unilateral pain in the larynx;
• severe coughing attacks;
• general weakness;
• fainting;
• increased activity endocrine glands, which is why it is produced excessive quantity gastric juice and pancreatic enzymes;
• sharp increase intestinal peristalsis, which negatively affects the digestive processes;
• disturbances of cardiac and respiratory activity - dizziness, arrhythmia, chest pain, difficulty breathing;
• the extreme stage of nerve damage is characterized by serious abnormalities for the body, including deafness and urinary incontinence.

Disorders of autonomic innervation (angioneurosis)

Symptoms: dizziness and hearing impairment, caused by disorders of the brain vessels due to diseases such as migraine, erythromelalgia, Meniere's disease and Raynaud's disease.

Sometimes the symptoms are not caused by damage at all, but by a change in the tone of the vagus nerve, which ensures the body’s adaptation to changes in conditions environment, and stress on the body (emotional and physical). With a decrease in tone, apathy, a feeling of loneliness, and interruptions in heart function are noted.

Diagnostics

Pathology can be determined even by visual examination:

• evaluate the sound of the voice - nasality appears, and the timbre of the voice decreases;
• the person cannot cough on purpose, the soft palate, relaxed due to paresis, sag slightly;
• pronouncing a vowel sound causes the tongue to deviate towards the affected side;
• the palatal and pharyngeal reflexes are impaired.

For final diagnosis it is necessary to use instrumental methods, such as magnetic resonance and computed tomography, radiographic examination of the skull and chest.

Treatment

Therapy for damage to the vagus nerve is a complex and lengthy process, which should only be carried out in a specialized hospital, since vital organs may suffer.

You should never self-medicate, as incorrect diagnosis or delayed treatment can lead to irreversible damage. nervous system, and in severe cases even to death.

Traditional medicine

Traditional medicine provides treatment for vagus nerve pathology in several areas.

Eliminating the cause

If the lesion is caused by an infection, antiviral or antibacterial drugs are of primary importance medicines. For neoplasms and injuries, it can only help surgery, eliminating pressure on the nerve trunk.

Symptomatic treatment

• Steroid hormonal drugs(prednisolone, dexamethasone) - are intended to relieve inflammation, the course of treatment is long, moreover, its regular correction is necessary;
• Prozerin - prescribed to normalize secretion gastric juice and intestinal motility;
• Diphenhydramine is an antihistamine and sedative;
• Multivitamin complexes in combination with B vitamins.

Rehabilitation therapy

• Milgamma - to normalize the structure of the nerve fiber;
• Electrical stimulation of the vagus nerve (implies the use of currents directed to the area of ​​​​painful sensations) can calm the vagus nerve;
• Plasmapheresis is blood purification at the cellular level.

At congenital lesion nerve the patient needs to have a pacemaker installed. Severe cases require the use of a breathing apparatus.

Folk remedies

Methods traditional medicine do not play an important role in the treatment of pathologies of the vagus nerve; they can only slightly reduce the intensity of symptoms and enhance the effect traditional treatment. Folk remedies should be used only with the consent of the attending physician.

To improve your well-being, you can take decoctions of thyme, clover, mint and lemon balm. Can improve the patient's condition medicinal baths, which include yarrow, calamus root, oregano herb, pine buds, lavender, rosemary leaves, peppermint leaves.

Unfortunately, the consequences of lesions of the vagus nerve are practically impossible to permanently cure. Therefore, at the first warning symptoms, you should immediately seek medical help.

Our nervous system has a complex structure, because it is responsible for the passage of all processes in our body. Problems in its activities are immediately reflected in the functioning of organs and systems, and require an attentive attitude and correct and timely correction. So one of the quite important parts The nervous system is the vagus nerve, it is a representative of the twelve nerves in our cranium (the tenth pair of cranial nerves). Damages to this area of ​​our body can affect the activity of the heart, bronchopulmonary system, intestines, etc. Correction of this pathological condition requires proper therapy under the supervision of a doctor.

The vagus nerve is quite different complex structure, because it contains motor, as well as secretory and sensory fiber. This fiber is responsible for conducting impulses entering the cerebral cortex and awakening all kinds of functions. Of course, damage to the vagus nerve negatively affects the activity of the entire body and can provoke the most various ailments.

Why is the vagus nerve damaged? Reasons

There are many factors that can cause damage to the vagus nerve. Let's try to look at the most common of them. So most often this pathological condition is most often caused by diabetes mellitus.

Damage to blood vessels caused by high blood sugar levels can cause inflammatory lesions, as well as damage to the vagus nerve. In addition, such an illness can develop as a result of a number of chronic illnesses, including HIV or Parkinson's disease. Such diseases have a rather negative effect on the activity of such an important fiber.

Serious problems with the vagus nerve can occur due to injuries and severe accidents. In addition, in certain cases, surgical interventions may, due to a combination of unforeseen circumstances, provoke sharp increase pressure on this area, which is also fraught with damage.

Another fairly common cause of problems of this kind is considered to be alcoholism, which provokes alcoholic neuropathy.

What indicates that the vagus nerve is damaged? Symptoms

Manifestations of lesions of the vagus nerve can be very different. Moreover, the severity of symptoms directly depends on the severity of the pathology. In most cases inflammatory processes and other lesions in this area cause problems with the voice, for example, cause hoarseness, various kinds difficulties in pronunciation, as well as a significant change in voice. The next stage in the development of pathological processes is considered to be disturbances in swallowing saliva or food.

Similar symptom is explained by the fact that the vagus nerve is responsible for the reflexes of tongue movements; accordingly, its lesions lead to movement dysfunctions. A failure in this same reflex function can cause the development of unreasonable gag reflexes, which can cause suffocation. As pathological processes develop, the patient experiences problems in the digestive process, which can be expressed in indigestion, constipation, etc. In addition, lesions of the vagus nerve can cause disturbances in the functioning of the heart and blood vessels, which manifests itself in arrhythmia, chest pain, breathing problems , as well as dizziness. Manifestations of this pathological condition can be expressed in both urinary incontinence and the development of deafness.

How is a damaged vagus nerve corrected? Treatment

Treatment of problems with the vagus nerve should be carried out exclusively under the supervision of a doctor. Significance proper treatment extremely high, since problems in the activity of such a part of our body can cause extremely serious complications, and in severe cases, provoke death.

Treatment of lesions of the vagus nerve is carried out only after confirmation of such a diagnosis by a qualified specialist. The doctor takes measures to eliminate the causes that provoked the pathology. The most common drugs used to correct this disease are considered to be hormonal compounds (Prednisolone), multivitamin medications (especially important role plays the use of B vitamins), as well as antihistamines and anticholinesterase medications. In certain cases, plasmapheresis may be performed.

If we talk about the use of physiotherapeutic treatment methods, doctors often recommend the use of diadynamic currents aimed at the location of pain. In certain cases, the only possible method treatment becomes surgery.

It is worth considering that treatment of damage to the vagus nerve should be carried out exclusively in a clinical setting.

The vagus nerve (n.vagus) is the tenth pair of cranial nerves and is classified as mixed. It is divided into 4 sections according to its topography. The vagus nerve is very long and runs from the skull to the middle gastrointestinal tract, which is why it has such an interesting name.

Topography

The vagus nerve has a rather complex topographic anatomy. This is explained by its length and the fact that the location of the right and left nerves is somewhat different from each other.

Both of these nerves begin in the same way. They are formed from a dozen fibers and extend from both sides to the base of the skull from the medulla oblongata. They then descend down through an opening in the skull. The first large node, the ganglion superius, is located here. The second is lower and is called ganglion inferius.

After both nerve trunks have reached the superior thoracic outlet, they begin to “behave” differently. The left vagus nerve is located on the anterior part of the aortic arch, and the right one is located near the subclavian artery.

Then they go around both bronchi from behind and approach the esophagus.

It passes down through the diaphragm to the upper floor abdominal cavity. IN epigastric region they are divided into many smaller branches that transmit impulses to the diaphragm, solar plexus and organs of the upper floor of the abdominal cavity.

The vagus nerve consists of the following fibers:

• Sensory fibers. They carry impulses from the organ to the brain. Fibers from the vessels of the respiratory organs, esophagus and stomach, cardiac muscle, and external auditory canal approach the sensitive nucleus of the n.vagus;
• Motor fibers. They transmit impulses in the opposite direction. From the motor nucleus, the fibers reach the muscles of the pharynx, soft palate, and larynx;
• Parasympathetic nerve fibers. They influence the autonomic function of the heart and control the muscular lining of blood vessels. They can also narrow the lumen of the bronchi, increase intestinal motility and affect all organs that are innervated by the vagus nerve.

Functions

The vagus nerve is divided into four sections according to its location. They vary in length and in each of them, smaller branches depart from the large nerve trunk that innervate nearby organs and fabrics.

The shortest head section. From this area depart fibers that innervate part of the dura mater of the brain (one of the causes of migraine), inner ear, as well as two connecting branches that lead to the eleventh and twelfth pairs of cranial nerves.

The branches of the cervical spine are responsible for the work of the muscles of the pharynx and larynx. If the vagus nerve is damaged in this section, the patient loses his voice and develops dysphagia. Also from this area small nerves depart, which are part of the cardiac and esophageal plexus.

The thoracic region ends at the level of the diaphragm. Two separate plexuses depart from it, which are responsible for the functioning of the esophagus and lungs. And also two types of branches - cardiac and bronchial.

The vagus nerve ends in the abdominal region. Here it is divided into anterior and posterior trunks, which innervate the stomach, pancreas, liver, and solar plexus.

The activity of n.vagus is increased mainly at night. This is explained by the fact that it is responsible for the functioning of the parasympathetic division of the autonomic nervous system.

The vagus nerve slows down the heartbeat and reduces the contraction of the nasty muscles of the bronchi. At the same time, secretion production by the stomach and pancreas increases. The greatest activity of this part of the nervous system occurs at night.

The vagus nerve is also responsible for coughing and vomiting, which are protective reflexes. We also owe the appearance of hiccups to pathological impulses that pass along the branches of the vagus nerve to the diaphragm.

Treatment of diseases is aimed at eliminating the symptoms that appear when the transmission of impulses along individual branches of the n.vagus is disrupted.

Diseases

The vagus nerve, like any part of the nervous system, is subject to various damages. Clinical picture The disease largely depends on the location of the lesion.

If the lesion is located inside the skull, then most often it is compression tumor neoplasms, consequences of traumatic brain injury, multiple sclerosis, ALS or infections that are tropic to nervous tissue.

The most common diseases that affect the peripheral part of the vagus nerve include neurasthenia, Raynaud's or Meniere's disease, paralysis or nerve paresis.

Vascular diseases are associated with pathological functioning of the vagus nerve.

Symptoms of vagus nerve dysfunction depend on the depth, extent and location of the lesion. First of all, the functioning of the vocal cords is disrupted. This is due to damage in cervical spine. The voice becomes quiet, hoarse, and may disappear completely. If both nerves are affected, suffocation may occur.

Another common symptom is difficulty swallowing. Water or liquid food may enter the nasopharynx.

The work of the heart is disrupted. The heartbeat slows down or speeds up, and its rhythm becomes uneven (arrhythmia). These symptoms prevail at night.

With serious damage to the n.vagus, paralysis may occur, which leads to death.

Research methods

If you have symptoms that indicate damage to the 10th pair of cranial nerves, you should contact a neurologist.

The doctor first determines the sonority of the voice. This is a simple research method that does not require cost or effort. You need to pay attention to the sound of the voice, its timbre and clarity of speech. A certain nasal sound may occur due to paresis of the soft palate. The timbre of the voice becomes lower due to the fact that vocal cords cannot close tightly enough. For the same reason, the patient is not able to cough on purpose.

Upon examination oral cavity the doctor draws attention to the fact that the soft palate is relaxed and sags slightly downwards. If you ask the patient to pronounce vowel sounds,
then the tongue will deviate towards the affected side.

As with any pathology of the nervous system, a weakening of some reflexes will be observed. With this lesion, the pharyngeal and palatal reflexes will not be fully determined.

For differential diagnosis, instrumental research methods are used: computer and magnetic resonance imaging, radiography of the skull and chest organs.

Therapy methods

Treatment of pathology of the vagus nerve should take place exclusively in a neurological hospital. This is due to the fact that it innervates vital organs (heart, lungs).

The most important stage of treatment is to eliminate the cause of the disease. Therefore it is necessary to pay attention differential diagnosis. If the disease has infectious etiology, then the main drug of therapy is antiviral or bactericidal drugs.

The main medications used to treat many diseases are steroid drugs. These include prednisolone and dexamethasone. The course of therapy is long and requires constant correction.

Also appointed symptomatic treatment. For example, when gastric secretion and intestinal motility are reduced, prozerin is used.

Vagal fibers conduct impulses to organs in the head (innervate the larynx, palate and middle ear), as well as the chest and abdominal cavities.

The main functions of the vagus nerve are related to the functioning of the parasympathetic nervous system. What does it mean? – In the human nervous system there are a pair of opposites – the sympathetic and parasympathetic nervous system.

Sympathetic– associated with the activation of the body, active work, is aimed at increasing the speed of reactions, intensive production of hormones, preparing for running and fighting.

Parasympathetic nervous system - prepares the body for relaxation, recuperation, digestion of food, sleep, sex and other activities related to pleasure. Thus, the vagus nerve partly regulates a person’s mood and sleep.

With chronic overexcitation of the nervous system, muscle hypertonicity and similar conditions, dysfunction of the vagus nerve can be assumed.

Where is the vagus nerve located? – You can feel it yourself directly in the hole under the earlobe.

Coming from the jugular foramen of the brain, the vagus descends along the side of the neck in the composition neurovascular bundle along with carotid artery and internal jugular vein. Passes near the trachea and pharynx, innervating them. Next, the vagus passes into the chest cavity, its right branch runs next to the right subclavian artery, and the left one is in front of the aortic arch. Both branches approach the lower part of the esophagus, passing from it in front and behind, and regulate its functions. Next, through the opening of the diaphragm, both nerve fibers enter the abdominal cavity. They innervate the stomach. Then some of the fibers go to the liver, some to the celiac (or solar) plexus. From the celiac plexus, fibers approach all organs of the abdominal cavity, except lower sections colon and pelvic organs.

The vagus nerve contains fibers responsible for motor skills and sensory skills (mixed type), but all its activities are still connected with the autonomic nervous system - from the word “vegetable” - “vegetable” (that which cannot be controlled by consciousness) - in contrast somatic nervous system - from the word “soma” - “body” (we can consciously control muscle movement).

Symptoms of dysfunction

Since the vagus nerve innervates the larynx, damage to it leads to problems with speech and uncomfortable swallowing, and loss of the gag reflex. Disruption of the gastrointestinal tract is also one of the manifestations of vagal dysfunction, manifested in loss of appetite, and a feeling of satiety may occur after eating a small amount of food.

Causes of defeat

One of the causes of damage to the vagus nerve is diabetes. The mechanism that destroys nerve fibers is not fully understood. Damage and irritation of the vagus nerve can also be caused by injuries to the body, for example, during car accident and others when a pinched nerve occurs. Surgery can also affect the functioning of the nerve.

Exercises to stimulate the vagus nerve

Preparation:

• Sit upright on a chair with your hands on your knees
• Place both feet on the floor and take a deep breath

Neck area

• Stretch your head as far as possible with the top of your head up and turn it left and right. Repeat this movement several times.

Lower jaw area

• Move lower jaw, slowly opening and closing your mouth, moving it from side to side, back and forth. Feel the muscles in your jaw, which may be causing tension. painful sensations. Do this exercise until you feel slight fatigue in your jaw.

Eyes

• Open and close your eyes. Look in different directions without moving your head - left and right, up and down. Alternately open your eyes wide and squint.

Facial muscles

• Think back to your childhood and spend a few minutes “making faces”, trying to use as many facial muscles as possible.

Middle ear

• Listen. Hear background environmental sounds, such as the creaking of chairs, the sound of tires of a car passing on the street, the sound of birds chirping, the sound of an elevator, the sound of a computer running, or the rustle of an air conditioner or fan.

Throat

• First, make a few “coughing” movements (as if something has entered the trachea), and then swallow the saliva.

Larynx

• Start developing your voice, for example, you can hiss like a snake, or roar like a lion. The main thing is that these sounds lead to tension in the muscles of the larynx.
• Feel the vibration in the larynx; the vibration sound should reach the diaphragm and spread throughout the abdomen.

Listen to how you feel, especially the sensation in your chest. Pay attention to every positive change, no matter how small. By performing this complex daily, you will increase the tone of the vagus nerve and the whole body, and revitalize your internal energy!

Many people, having heard the name “vagus nerve” ”, wondering why this particular phrase is used. The fact is that several pairs of nerves are connected to the human brain. Each of them is responsible for a specific area of ​​the body, for example, the first, second and eighth - for the difference in sound, smell and light. But the tenth is called wandering.

This pair starts from the cranial region and affects almost all other nerve fibers. They transmit signals to the organs, causing them to become excited. It got its name from the Latin word vargus - its branches are in the head, cervical, thoracic and abdominal regions, it seems to be wandering through the body.

This pair affects many natural reflexes, such as swallowing, vomiting, coughing, and gastric emptying. In addition, it regulates such important processes as breathing and heartbeat, and also forms the solar plexus.

Pathologies of the vagus nerve

Like any part of the body, it is susceptible to various diseases.

They are divided into types:

• Neurasthenia is a disorder characterized by irritability, excitability, exhaustion and weakness. In this situation, the functions of the autonomic system suffer;
• Angioneuroses. These diseases develop when the functioning of blood vessels is impaired as a result of a disorder autonomic innervation. For example, these are ailments such as erythromelalgia, migraine, Meniere's disease and Raynaud's disease.

Migraine is a severe attack-like headache intolerable character. Raynaud's disease is characterized by emotional irritation, pallor and cyanosis of parts of the face and fingers, while the lesions are always symmetrical. Meniere's disease is characterized by damage to segments of the brain and peripheral parts nervous system. The main symptoms are dizziness and hearing loss.

Treatment of pathologies of the vagus nerve is a complex and lengthy process. Illnesses of this nature significantly affect the patient’s quality of life and are difficult to treat. Therefore, when the first warning signs You must contact your doctor to prescribe an adequate course.

An important point in the treatment of any disease is timely diagnosis. The patient must strictly follow the specialist’s instructions and make every effort to recover.

Surgical stimulation of the vagus nerve for epilepsy

This option is used in particularly difficult cases, as well as in the absence of effect from medicines. The deep brain stimulation method involves implanting electrodes into certain segments of the organ.

Deep stimulation is used in cases where the part of the brain responsible for epileptic seizures cannot be removed.

The effect of the procedure occurs within two years from the date of its implementation. However medications are not canceled, but are used as additional treatment. If stimulation is effective, then either the number of seizures is reduced or they disappear altogether.

The electrodes are connected to a neurostimulator, a special battery-powered device that sends electrical impulses to the brain. They pass through wires into the thalamus via implanted electrodes.

This treatment, like any other, can cause side effects: paresthesia (slight tingling), memory impairment, depression. Although this happens rarely and goes away over time, it is not completely excluded.

If there is no improvement and the symptoms of vagus nerve pathology remain severe, a decision is made to remove the electrodes and turn off the stimulator.

Causes of nerve inflammation

Damage can be caused by a wide range of factors. The most common is diabetes mellitus. When blood sugar levels rise, blood vessels become damaged, which leads to inflammation. Pathologies such as HIV and Parkinson's disease affect the body in a similar way. Severe injuries occur in the event of injuries and accidents. Another reason is bad habits(alcohol, smoking).

Symptoms of vagus nerve damage

When its performance is impaired, paralysis of the muscles of the pharynx and esophagus occurs first, so it becomes difficult to swallow. The process also affects the palate, as a result, liquid food can flow into the nose. During an examination of the oral cavity, the doctor notices a sagging soft palate.

At the same time, the tone of the voice changes, it becomes as if nasal, and also hoarse, since the vocal cords also suffer. If the damage is symmetrical, suffocation may occur. At the same time, the functioning of the heart muscle is disrupted, resulting in bradycardia or tachycardia. In the vast majority of cases it functions poorly digestive system, urinary incontinence and deafness are observed.

Separately, it is worth mentioning the neuralgia of the vagus nerve, more precisely, its specific branch - the upper laryngeal section.

The causes of this disorder have not yet been established, but medical experts are inclined to believe that this occurs when the laryngeal nerve is compressed pathological process. At the same time, the sick person feels weakness, pain and is overtaken by severe cough. On palpation, pain occurs above the thyroid cartilage.

If the vagus nerve is affected, then arrhythmia occurs. IN in this case make a diagnosis " Vague-dependent neurogenic arrhythmia" It develops due to the activation of the parasympathetic system, and the tenth pair of nerves in particular. Vague-dependent disorders in the heart often appear at night.

They provoke other abnormalities - diseases of the intestines, gall and bladder, stomach. We can say that irritation of the tenth pair leads to other diseases, which can serve as a cause for the development of other unfavorable conditions, and arrhythmia is no exception.

For those who suffer congenital pathology tenth pair of nerves, a pacemaker or breathing apparatus is required. Such measures are necessary to ensure stable functioning of the heart and digestive system and restore nutritional function. Diseases of the vagus nerve have a strong destructive effect on the body, so patients need help in conditions medical institution.

The most common diagnosis is an acquired disease. It is usually caused by injury. As a result, a person needs to re-adapt to the conditions of normal life. When inflammation occurs as a result of temporary exposure, it is quite possible to cure this pathology.

Usually this is observed next state: difficulty chewing, swallowing, fainting. Only a specialist in a medical facility can make an accurate diagnosis. After a course of therapy and rehabilitation, a person will be able to lead a normal life.

Treatment of pathologies of the vagus nerve folk remedies ineffective. To eliminate arrhythmia, you can drink infusions and decoctions of soothing herbs, but they can only be useful if it is not caused by a more serious pathology, such as diabetes.

Diagnosis of lesions of the tenth pair of nerves

To make an accurate diagnosis, the doctor determines the sonority of the voice. Usually it is weakened or completely absent. The purity of pronunciation of sounds is taken into account. The soft palate is examined, the uvula is symmetrically positioned. In this case, a spatula is used.